Hospital Based Emergency Department Visits With Dental Conditions: Outcomes and Policy Implications in the States of California, Nebraska and New York

The purpose of this dissertation was to present state-level estimates of hospital-based emergency department (ED) visits with dental conditions across all ages in the states of California, Nebraska, and New York. Also, this dissertation examined the outcomes and impact of changes in Medicaid policies on the utilization of ED with dental problems. State Emergency Department Databases (California, Nebraska, and New York), a component of the Healthcare Cost and Utilization Project (HCUP) was used for this dissertation. Dental conditions were identified by using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. High-risk groups visiting EDs with dental conditions were identified. This dissertation highlights the need for the provision of increased resources, such as dental-related preventive programs and community clinics particularly for the high-risk groups who visit ED for dental problems

An Examination of Private Payer Reimbursements to Primary Care Providers for Healthcare Services Using Telehealth, United States 2009–2013

Half of telehealth-related state policies were implemented in the last five years. Although many states permit reimbursements for telehealth services, only seven states have passed statutes mandating parity with reimbursements for non-telehealth services. Despite an increasing number of telehealth policies, claims for telehealth services to private insurers are rare. Lower average reimbursements for telehealth billings may discourage adoption of telehealth technologies. Surveillance of claims data will help identify whether telehealth policies are having their intended impact on the healthcare system.https://digitalcommons.unmc.edu/coph_policy_reports/1026/thumbnail.jp

Legal Mapping Analysis of State Telehealth Reimbursement Policies

Background: There exists rapid growth and inconsistency in the telehealth policy environment, which makes it difficult to quantitatively evaluate the impact of telehealth reimbursement and other policies without the availability of a legal mapping database. Introduction: We describe the creation of a legal mapping database of state-level policies related to telehealth reimbursement of healthcare services. Trends and characteristics of these policies are presented. Materials and Methods: Information provided by the Center for Connected Health Policy was used to identify state-wide laws and regulations regarding telehealth reimbursement. Other information was retrieved using: (1) LexisNexis database, (2) Westlaw database, and (3) retrieval from legislative websites, historical documents, and contacting state officials. We examined policies for live video, store and forward, and remote patient monitoring (RPM). Results: In the United States, there are 24 states with policies regarding reimbursement for live video transmission. Fourteen states have store and forward policies and 6 states have RPM related policies. Mississippi is the only state that requires reimbursement for all three types of telehealth transmission modes. Most states (47 states) have Medicaid policies regarding live video transmission, followed by 37 states for store and forward and 20 states for RPM. Only thirteen states require that live video will be reimbursed “consistent with” or at the “same rate” as in-person services in their Medicaid program. Discussion: There are no widely accepted telehealth reimbursement policies across states. They contain diverse restrictions and requirements that present complexities in policy evaluation and determining policy effectiveness across states

Cross‐Sectional Analysis of National Dental Residency Match Data

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/153612/1/jddj002203372017813tb06272x.pd

Assessing health professionals’ perception of health literacy in Rhode Island community health centers: a qualitative study

Background: Limited health literacy is linked with poor health behaviors, limited health care access, and poor health outcomes. Improving individual and population health outcomes requires understanding and addressing barriers to promoting health literacy. Methods: Using the socio-ecological model as a guiding framework, this qualitative study (Phase 1 of a larger ongoing project) explored the interpersonal and organizational levels that may impact the health literacy levels of patients seeking care at federally qualified community health centers (FQCHCs) in Rhode Island. Focus groups were conducted with FQCHC employees (n = 37) to explore their perceptions of the health literacy skills of their patients, health literacy barriers patients encounter, and possible strategies to increase health literacy. The focus groups were audio-recorded and transcribed, and transcripts were coded using a process of open, axial, and selective coding. Codes were grouped into categories, and the constant comparative approach was used to identify themes. Results: Eight unique themes centered on health literacy, sources of health information, organizational culture’s impact, challenges from limited health literacy, and suggestions to ameliorate the impact of limited health literacy. All focus group participants were versed in health literacy and viewed health literacy as impacting patients’ health status. Participants perceived that some patients at their FQCHC have limited health literacy. Participants spoke of themselves and of their FQCHC addressing health literacy through organizational- and provider-level strategies. They also identified additional strategies (e.g., training staff and providers on health literacy, providing patients with information that includes graphics) that could be adopted or expanded upon to address and promote health literacy. Conclusions: Study findings suggest that strategies may need to be implemented at the organizational-, provider-, and patient- level to advance health literacy. The intervention phase of this project will explore intervention strategies informed by study results, and could include offering health literacy training to providers and staff to increase their understanding of health literacy to include motivation to make and act on healthy decisions and strategies to address health literacy, including the use of visual aids

Opioid abuse/dependence among those hospitalized due to periapical abscess

AimOpioid abuse/dependence (OAD) is an emerging public health crisis in the USA. The aim of the present study was to estimate the nationwide prevalence of OAD in those hospitalized due to periapical abscess in the USA.MethodsThe Nationwide Inpatient Sample for 2012‐2014 was used. All patients who were hospitalized due to periapical abscess were selected for analysis. In this cohort, OAD was identified and used as the outcome variable. A mix of patient and geographic factors were used as independent variables. The simultaneous association between outcome and independent variables was examined by a multivariable logistic regression model. Clustering of outcomes within hospitals was adjusted. Odds of OAD were computed for all independent variables.ResultsDuring the study period, 30 040 patients were hospitalized due to periapical abscess; 1.5% of these had OAD. Those aged 18‐29 years (odds ratio [OR] = 3.69, 95% confidence interval [CI] = 1.76‐7.72, P < 0.01) and 30‐44 years (OR = 3.19, 95% CI = 1.77‐5.76, P < 0.01) were associated with higher odds for OAD compared to those aged 45‐64 years. Blacks were associated with lower odds for OAD compared to whites (OR = 0.52, 95% CI = 0.28‐0.95, P = 0.03). Those covered by Medicare (OR = 4.08, 95% CI = 1.458‐11.44, P = 0.01), Medicaid (OR = 5.86, 95% CI = 2.22‐15.47, P < 0.01), and those who were uninsured (OR = 3.68, 95% CI = 1.30‐10.45, P = 0.01) were associated with higher odds for OAD compared to those covered by private insurance. The odds of OAD increased with comorbid burden (OR = 1.66, 95% CI = 1.50‐1.84, P < 0.01).ConclusionsHigh‐risk groups that are likely to have OAD were identified among those hospitalized due to periapical abscess.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/146647/1/jicd12354.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/146647/2/jicd12354_am.pd

Outcomes of Acute Chest Syndrome in Adult Patients with Sickle Cell Disease: Predictors of Mortality

Adults with sickle cell disease(SCD) are a growing population. Recent national estimates of outcomes in acute chest syndrome(ACS) among adults with SCD are lacking. We describe the incidence, outcomes and predictors of mortality in ACS in adults. We hypothesize that any need for mechanical ventilation is an independent predictor of mortality. Methods: We performed a retrospective analysis of the Nationwide Inpatient Sample(2004–2010),the largest all payer inpatient database in United States, to estimate the incidence and outcomes of ACS needing mechanical ventilation(MV) and exchange transfusion(ET) in patients >21 years. The effects of MV and ET on outcomes including length of stay(LOS) and in-hospital mortality(IHM) were examined using multivariable linear and logistic regression models respectively. The effects of age, sex, race, type of sickle cell crisis, race, co-morbid burden, insurance status, type of admission, and hospital characteristics were adjusted in the regression models. Results: Of the 24,699 hospitalizations, 4.6% needed MV(2.7% for <96 hours, 1.9% for ≥96 hours), 6% had ET, with a mean length of stay(LOS) of 7.8 days and an in-hospital mortality rate(IHM) of 1.6%. There was a gradual yearly increase in ACS hospitalizations that needed MV(2.6% in 2004 to 5.8% in 2010). Hb-SS disease was the phenotype in 84.3% of all hospitalizations. After adjusting for a multitude of patient and hospital related factors, patients who had MV for <96 hours(OR = 67.53,p<0.01) or those who had MV for ≥96 hours(OR = 8.73,p<0.01) were associated with a significantly higher odds for IHM when compared to their counterparts. Patients who had MV for ≥96 hours and those who had ET had a significantly longer LOS in-hospitals(p<0.001). Conclusion: In this large cohort of hospitalized adults with SCD patients with ACS, the need for mechanical ventilation predicted higher mortality rates and increased hospital resource utilization. Identification of risk factors may enable optimization of outcomes

Infection Related Never Events in Pediatric Patients Undergoing Spinal Fusion Procedures in United States: Prevalence and Predictors

OBJECTIVE: To examine the prevalence and predictors of infection related never events (NE) associated with spinal fusion procedures (SFP) in children (age < = 18 years) in the United States. METHODS: We performed a retrospective analysis of the Nationwide Inpatient Sample for the years 2004 to 2008. All pediatric hospitalizations that underwent SFP were selected for analysis. The main outcomes measures include occurrence of certain NE's. The association between the occurrence of a NE and factors (patient & hospital related) were examined using multivariable logistic regression analysis. RESULTS: Of 56,465 hospitalizations, 61.7% occurred among females. The average age was 13.7 y and two-thirds were whites. The major insurance payer was private insurance (67.4%). About 82% of all hospitalizations occurred on an elective basis. Teaching hospitals accounted for a majority of hospitalizations (87.9%). Two-thirds were posterior fusion techniques, 52.3% had underlying musculoskeletal deformities, and the most frequently present co-morbid conditions (CMC) included paralysis (10.9%), chronic pulmonary disease (9.7%), and fluid/electrolyte disorders (7.6%). Overall rate of occurrence of a NE was 4.8%. Post-operative pneumonia was the most frequently occurring NE (2.9%). Female gender (OR = 0.78) and elective admissions (OR = 0.66) were associated with lower risk of NE occurrence. Medicaid coverage (OR = 1.46), primary diagnosis of other acquired deformities (OR = 1.82), spinal cord injury (OR = 6.94), other nervous system disorders (OR = 2.84) were associated with higher risk of NE occurrence. Among CMC, those with chronic blood loss anemia (OR = 2.57), coagulopathy (OR = 1.97), depression (OR = 2), drug abuse (OR = 3.71), fluid/electrolyte disorders (OR = 2.62), neurological disorders (OR = 1.72), paralysis (OR = 1.75), renal failure (OR = 5.45), and weight loss (OR = 4.61) were risk factors for higher odds of a NE occurrence. Hospital teaching status, region, hospital size, and patient race did not influence the occurrence of NE. CONCLUSION: The never events examined in the current study occurred in 4.8% of children hospitalized with SFP. Certain predictors of NE are identified in this study

Hospital Based Emergency Department Visits Attributed to Child Physical Abuse in United States: Predictors of In-Hospital Mortality

Objectives: To describe nationally representative outcomes of physical abuse injuries in children necessitating Emergency Department (ED) visits in United States. The impact of various injuries on mortality is examined. We hypothesize that physical abuse resulting in intracranial injuries are associated with worse outcome. Materials and Methods We performed a retrospective analysis of the Nationwide Emergency Department Sample (NEDS), the largest all payer hospital based ED database, for the years 2008–2010. All ED visits and subsequent hospitalizations with a diagnosis of “Child physical abuse” (Battered baby or child syndrome) due to various injuries were identified using ICD-9-CM (International Classification of Diseases, 9th Revision, Clinical Modification) codes. In addition, we also examined the prevalence of sexual abuse in this cohort. A multivariable logistic regression model was used to examine the association between mortality and types of injuries after adjusting for a multitude of patient and hospital level factors. Results: Of the 16897 ED visits that were attributed to child physical abuse, 5182 (30.7%) required hospitalization. Hospitalized children were younger than those released treated and released from the ED (1.9 years vs. 6.4 years). Male or female partner of the child’s parent/guardian accounted for >45% of perpetrators. Common injuries in hospitalized children include- any fractures (63.5%), intracranial injuries (32.3%) and crushing/internal injuries (9.1%). Death occurred in 246 patients (13 in ED and 233 following hospitalization). Amongst the 16897 ED visits, 1.3% also had sexual abuse. Multivariable analyses revealed each 1 year increase in age was associated with a lower odds of mortality (OR = 0.88, 95% CI = 0.81–0.96, p<0.0001). Females (OR = 2.39, 1.07–5.34, p = 0.03), those with intracranial injuries (OR = 65.24, 27.57–154.41, p<0.0001), or crushing/internal injury (OR = 4.98, 2.24–11.07, p<0.0001) had higher odds of mortality compared to their male counterparts. Conclusions: In this large cohort of physically abused children, younger age, females and intracranial or crushing/internal injuries were independent predictors of mortality. Identification of high risk cohorts in the ED may enable strengthening of existing screening programs and optimization of outcomes